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Baby's 1ST Year

Colic May Just Be a Normal Part of Baby's Development

Pediatrics: The constant crying is probably a temporary stage, coupled with a sensitive temperament, some experts say.

October 19, 1998|KATHLEEN KELLEHER | SPECIAL TO THE TIMES

"You know your baby has colic," says one pediatrician versed in the phenomenon, "when you have an irresistible urge to get him his own apartment."

Sure, this is funny. But only if you don't have a colicky baby in your household. Colic, perhaps the most difficult syndrome of early infancy a parent faces, is defined by the American Academy of Pediatrics as unexplained crying that lasts one to two hours (or more) and occurs once or twice a day in an otherwise healthy baby, age 2 weeks to 4 months.

The crying of colic has been described as crying of the highest intensity, indistinguishable from crying caused by acute pain, hunger or loneliness. The baby is inconsolable and appears to be in pain with legs crunched, back arched, tummy tight, red face and fists formed. Some babies also pass gas. An estimated 10% of babies have colic.

Theories about what causes colic--a baby's underdeveloped nervous system, underdeveloped digestive tract, milk protein intolerance, swallowed air--are as varied as treatments (heating pads, antigas medicine, enemas, hypoallergenic formulas, vibrating cribs, baby holding methods, white noise). While there is no consensus on what causes colic, a number of researchers and pediatric gastroenterologists are beginning to see colic as a normal part of early development combined with a sensitive temperament rather than an abnormality or a sign of pain.

"The real take-home message from all the research has to be that the majority of these kids are not in pain," says David R. Fleisher, associate professor of gastroenterology at the University of Missouri School of Medicine, Department of Child Health, who recently wrote an overview article on colic research and treatment for the journal Contemporary Pediatrics.

"Virtually all the studies that have looked at antispasm, antigut medicine found that none of them worked. Most colicky babies are not allergic [to milk]--the majority do not respond to switching to hypoallergenic formula. The other thing is it is an on-and-off phenomenon, which would not occur in a kid who is in pain or hungry."

*

The concern that there may be something seriously wrong with an inconsolable baby who isso wracked by hard crying that his body distorts is understandable. Naturally, a pediatrician should be consulted to rule out any potential illnesses. But Ron Barr, a professor of pediatrics and psychiatry at McGill University who has conducted numerous studies investigating the causes and treatment for colic, speculates that only roughly one out of 20 infants actually has an organic disease contributing to colic. (There are no definitive studies showing the rate of organic diseases in colicky babies.)

Research conducted by guru pediatrician T. Berry Brazelton established that healthy babies, regardless of temperament, cry more in the first four months of life. Crying peaks at 6 weeks to an average of 3 1/2 hours a day but declines at about 3 months to about an hour and 20 minutes, where it stabilizes for the first year of life. Crying declines at 3 months, Brazelton and other pediatricians postulate, because as a baby matures developmentally, she is better able to communicate her needs to parents and better able to soothe herself (by finding a pacifier or thumb).

During this period of increased crying, Brazelton and a number of other pediatricians hypothesize, babies, particularly those of a "hypersensitive, hyperreactive temperament," are more likely to blow off stress from a full day of environmental stimuli with a good cry.

"They simply react to anything that perturbs them by crying intensely," says Tom Metcalf, a pediatrician in Salt Lake City whose double-blind study found that an antigas treatment was no more effective than a placebo in treating colicky babies. "The kid cannot regulate or calm himself so he freaks out and cries," Metcalf says.

What makes babies cry, particularly those with a hypersensitive temperament, says Fleisher, is difficulty adjusting to different states during the day (from awake to sleep, from empty stomach to full, from a day of activity to low stimulation). Crying is the way these babies cope with change. As a baby reaches 3 or 4 months, crying lessens as babies are given the opportunity to learn to soothe and calm themselves.

*

No matter the cause, a colicky baby is probably one of the most difficult of situations for parents. Despite all the speculation, there is no cure. Parents of colicky babies, however, may draw optimism from this: The worst should be over by the time baby is 3 or 4 months old. In the meantime, here are some sound coping strategies developed by the experts:

* If your baby cries for more than a couple of hours a day and is inconsolable, see your pediatrician. The doctor will take a history of the baby's symptoms and may want to observe the baby in a crying jag. Parents need 24-hour accessibility to a pediatrician who knows the baby, so the infant can be reassessed whenever concerns about health arise.

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